Download PDF
Int J Sports Med 2007; 28(4): 333-339
DOI: 10.1055/s-2006-924396
Clinical Sciences

© Georg Thieme Verlag KG Stuttgart · New York

Relationship between Dyspnea Increase and Ventilatory Gas Exchange Thresholds during Exercise in Children with Surgically Corrected Heart Impairment

V. Amiard1 , 2 , H. Jullien1 , D. Nassif2 , Y. Maingourd1 , 2 , S. Ahmaidi1
  • 1Laboratoire de Recherches EA-3300 “APS et Conduites Motrices: Adaptations et Réadaptations”, Faculté des Sciences du Sport, Université de Picardie Jules Verne, Amiens Cedex, France
  • 2Service d'Explorations Cardio-Pulmonaires Pédiatriques, CHU Amiens Nord, Amiens Cedex, France
Further Information

Publication History

Accepted after revision: May 20, 2006

Publication Date:
06 October 2006 (online)

Also available at
    Permissions and Reprints

Abstract

To study the relationship between the onset of an increase in dyspnea and ventilatory threshold (VT) in children with congenital heart impairment, sixteen young subjects underwent a cardiopulmonary exercise test with dyspnea perception and ventilatory gas exchange assessments. Dyspnea score was measured from a visual analogical scale at rest and during each step of an incremental exercise test. Dyspnea score was plotted against oxygen uptake and the onset of an increase in dyspnea (DT) was determined when a brutal disruption occurs on the dyspnea score-oxygen uptake curve. VT was defined from gas exchange according to Beaver's method [[7]]. The first breakdown point in the oxygen uptake-carbon dioxide production relationship locates VT. Oxygen uptake (V·O2), pulmonary ventilation (V·E), heart rate (HR), oxygen pulse (O2 pulse = V·O2/HR), carbon dioxide production (V·CO2) and power output (P) were measured both at VT and DT effort level. Results pointed out that there was no significant difference between the cardiorespiratory variables measured respectively at VT and DT: V·O2 (VTV·O2 = 16.71 ± 2.65 vs. DTV·O2 = 18.34 ± 5.74 ml · kg-1 · min-1), V·E (VTV·E = 24.33 ± 6.86 vs. DTV·E = 26.82 ± 9.59 l · min-1), (VTV·CO2 = 789.31 ± 165.17 vs. DTV·CO2 = 924.02 ± 342.28 ml · min-1), HR (VTHR = 116 ± 10 vs. DTHR = 123 ± 20 beat · min-1), O2 pulse (VT O2 pulse = 7.83 ± 2.00 vs. DT O2 pulse = 8.01 ± 2.13 ml · kg-1 · beat-1), and P (VTP = 43 ± 16 vs. DTP = 52 ± 27 W). Moreover, the cardiorespiratory variables measured at DT and VT were closely related: V·O2 (r = 0.64, p < 0.01), V·E (r = 0.51, p < 0.01), HR (r = 0.75, p < 0.02), O2 pulse (r = 0.90, p < 0.001), and P (r = 0.80, p < 0.01). In addition, according to Bland and Altman's procedure [[8]], the onset of dyspnea increase and ventilatory threshold were shown in close agreement for the cardiorespiratory variables measured at these effort levels. The standard errors of the estimates were low. It was concluded that dyspnea and ventilatory gas exchange thresholds occur concomitantly and were strongly correlated in children with congenital heart impairment. The use of the onset of dyspnea increase for aerobic capacity assessment may be a good alternative to ventilatory gas exchange threshold measurement.

Key words

Congenital heart disease - ventilatory threshold - dyspnea threshold - dyspnea rating

References

  • 1 Adams L, Lane R, Shea S R, Cockcroft A, Guz A. Breathlessness during different forms of ventilatory stimulation: a study in normal subjects and respiratory patients.  Clin Sci. 1985;  69 673-682
    PubMedGoogle Scholar
  • 2 Adams L, Chronos N, Lane R, Guz A. The measurements of breathlessness induced in normal subjects: validity of two scaling techniques.  Clin Sci. 1985;  69 7-16
    PubMedGoogle Scholar
  • 3 Ahmaidi S, Varray A, Savy-Paccaux A, Préfaut C. Cardiorespiratory fitness evaluation by the shuttle test in asthmatics during aerobic training.  Chest. 1993;  103 1135-1141
    CrossrefPubMedGoogle Scholar
  • 4 Aitken R. Measurement of feeling using a visual analog scale?.  Proc Soc Med. 1969;  62 989-993
    PubMedGoogle Scholar
  • 5 Altose M. Assessment and management of breathlessness.  Chest. 1985;  88 775-835
    PubMedGoogle Scholar
  • 6 Baker R R, Mishoe S C, Zaitoun F H, Arant C B, Lucas J, Rupp N T. Poor perception of airway obstruction in children with asthma.  J Asthma. 2000;  37 613-624
    PubMedGoogle Scholar
  • 7 Beaver W L, Wasserman K, Whipp B J. A new method for detecting anaerobic threshold by gas exchange.  J Appl Physiol. 1986;  60 2020-2027
    CrossrefPubMedGoogle Scholar
  • 8 Bland J M, Altman D G. Statistical methods for assessing agreement between two methods of clinical measurement.  Lancet. 1986;  8 307-310
    PubMedGoogle Scholar
  • 9 Casaburi R, Patessio A, Ioli F, Zanaboni S, Donner C F, Wasserman K. Reductions in exercise lactic acidosis and ventilation as a result of exercise training in patients with obstructive lung disease.  Am Rev Respir Dis. 1991;  143 9-18
    CrossrefPubMedGoogle Scholar
  • 10 Chonan T, Mulholland M B, Leitner J, Altose M D, Cherniack N S. Sensation of dyspnea during hypercapnia, exercise and voluntary hyperventilation.  J Appl Physiol. 1990;  69 2100-2106
    PubMedGoogle Scholar
  • 11 Demediuk B, Manning H, Lilly J. Dissociation between dyspnea and respiratory effort.  Am Rev Respir Dis. 1992;  146 1222-1225
    PubMedGoogle Scholar
  • 12 Donner C, Howard P. Pulmonary rehabilitation in chronic pulmonary disease (COPD) with recommendations for its use.  Eur Resp J. 1992;  2 266-275
    PubMedGoogle Scholar
  • 13 EI-Manshawi A, Killian K J, Summers E, Jones N L. Breathlessness during exercise with and without resistive loading.  J Appl Physiol. 1986;  61 896-905
    PubMedGoogle Scholar
  • 14 Ensing G, Heise C T, Driscoll D J. Cardiovascular response to exercise after the Mustard operation for simple and complex transposition of great arteries.  Am J Cardiol. 1988;  62 617-622
    CrossrefPubMedGoogle Scholar
  • 15 Hanssen J E, Sue D Y, Orren A, Wasserman K. Relation of oxygen uptake to work rate in normal men and men with circulatory disorders.  Am J Cardiol. 1987;  59 669-674
    CrossrefPubMedGoogle Scholar
  • 16 Hansson P. Exercise testing and training in patients with chronic heart failure.  Med Sci Sports Exer. 1994;  26 527-537
    PubMedGoogle Scholar
  • 17 Horowitz M B, Littenberg B, Mahler D A. Dyspnea rating for prescribing exercise intensity in patients with COPD.  Chest. 1992;  109 1169-1175
    PubMedGoogle Scholar
  • 18 Horowitz M B, Mitchell B, Mahler D A. Dyspnea ratings for prescription of cross-modal exercise in patients with COPD.  Chest. 1998;  113 60-64
    PubMedGoogle Scholar
  • 19 Killian K J. The objective measurement of breathlessness.  Chest. 1985;  88 (Suppl 2) 845-905
    PubMedGoogle Scholar
  • 20 Killian K J, Bucens D D, Campbell E MJ. Effect on breathing patterns on the perceived magnitude of added loads to breathing.  J Appl Physiol. 1982;  52 578-584
    PubMedGoogle Scholar
  • 21 Lachman A, Sanna A, Dekoster J. Evaluation of dyspnea during exercise in COPD.  Am Rev Respir Dis. 1990;  141 A880
    PubMedGoogle Scholar
  • 22 Lane A, Cockcroft A, Guz A. Voluntary isocapnic hyperventilation and breathlessness during exercise in normal subjects.  Clin Sci. 1987;  73 519-523
    PubMedGoogle Scholar
  • 23 Leblanc P, Bowie D, Summers E, Jones N, Killian K. Breathlessness and exercise in patients with cardiorespiratory disease.  Am Rev Resp Dis. 1986;  133 21-25
    PubMedGoogle Scholar
  • 24 Leuenberger P. Study of dyspnea by the pneumologist: methodology and functional approach.  Schweiz Med Wochenschr. 1989;  18 (119) 1628-1632
    PubMedGoogle Scholar
  • 25 Loiseau A, Dubreuil C, Pujet J C. A visual analog scale of exercise dyspnea.  Rev Mal Respir. 1990;  1 39-44
    PubMedGoogle Scholar
  • 26 Mador M J, Kufel T J. Reproducibility of visual analog scale measurements of dyspnea in patients with chronic obstructive pulmonary disease.  Am Rev Respir Dis. 1992;  146 82-87
    PubMedGoogle Scholar
  • 27 Messner-Pellenc P, Ximenes C, Cleanto B, Mercier J, Groulleau R, Prefaut C. Cardiopulmonary exercise testing, determinant of dyspnea due to cardiac or pulmonary limitation.  Chest. 1994;  106 354-360
    PubMedGoogle Scholar
  • 28 Muza S R, Silverman M T, Gilmore G C, Hellerstein H K, Kelsen S G. Comparison of scales used to quantitate the sense of effort to breathe in patients with chronic obstructive lung disease.  Am Rev Respir Dis. 1990;  141 153-159
    PubMedGoogle Scholar
  • 29 Noseda A, Carpiaux J P, Schmenber J. Dyspnoea assessed by visual analogue scale in patients with chronic obstructive lung disease during progressive and high intensity exercise.  Thorax. 1992;  47 363-368
    PubMedGoogle Scholar
  • 30 Patessio A, Carone M, Ioli F, Donner C F. Ventilatory and metabolic changes as a result of exercise training in COPD patients.  Chest. 1992;  101 274S-278S
    PubMedGoogle Scholar
  • 31 Rampulla C, Baiocchi S, Dacosto E, Ambrosino N. Dyspnea on exercise: Pathologic mechanisms.  Chest. 1992;  101 248S-252S
    PubMedGoogle Scholar
  • 32 Reybrouck T, Weymans M, Stijns H, Knops J, Van der Hauwaert L. Ventilatory anaerobic threshold in healthy children.  Eur J Appl Physiol. 1985;  54 278-284
    PubMedGoogle Scholar
  • 33 Reybrouck T, Weymans M, Stijns H, Knops J, Van der Hauwaert L. Exercise testing correction of tetralogy of Fallot: the fallacy of a reduced heart rate response.  Am Heart J. 1986;  112 998-1003
    CrossrefPubMedGoogle Scholar
  • 34 Sergysels R. Evaluation of dyspnea during exercise testing.  Eur Respir Rev. 1995;  25 24-26
    PubMedGoogle Scholar
  • 35 Simon P, Schwartzstein R, Weiss J, Lahive K, Fencl V, Teghtsoonian M, Weinberger S E. Sensations of breathlessness induced in normal volunteers.  Am Rev Respir Dis. 1989;  140 1021-1027
    CrossrefPubMedGoogle Scholar
  • 36 Simon P, Schwartzstein R, Weiss J, Fencl V, Teghtsoonian M, Weinberger S E. Distinguishable types of dyspnea in patients with shortness of breath.  Am Rev Respir Dis. 1990;  142 1009-1014
    PubMedGoogle Scholar
  • 37 Stark R, Gambles S, Chatterjee S. An exercise test to assess clinical dyspneoa: estimation of reproducibility and sensitivity.  Br J Dis. 1982;  76 269-278
    PubMedGoogle Scholar
  • 38 Supinski G, Clary S, Bark H, Kelsen S. Effect of inspiratory muscle fatigue on perception of effort during loaded breathing.  J Appl Physiol. 1978;  62 300-307
    PubMedGoogle Scholar
  • 39 Varray A, Mercier J, Terral C, Préfaut C. Effect of individualized aerobic and high intensity training on asthmatic children in an exercise readaptation program: is training helpful for better adaptation to exercise?.  Chest. 1991;  99 574-586
    PubMedGoogle Scholar
  • 40 Wasserman K, Whipp B J, Koyal S N, Beaver W L. Anaerobic threshold and respiratory gas exchange during exercise.  J Appl Physiol. 1973;  35 236-243
    CrossrefPubMedGoogle Scholar
  • 41 Wasserman K, Whipp B J. Exercise physiology in health and disease.  Am Rev Respir Dis. 1975;  112 219-249
    PubMedGoogle Scholar
  • 42 Wasserman K, Hansen J, Sue D, Whipp B, Casabury R. Principles of Exercise Testing and Interpretation. 2nd edn. Philadelphia, PA; Lea and Febiger 1994
    Google Scholar
  • 43 Weber K, Janieki J, Mc Elroy P A. Determination of aerobic capacity and the severity of chronic heart failure.  Circulation. 1987;  76 (Suppl VI) 40-45
    PubMedGoogle Scholar
  • 44 Wilson R, Jones P. A comparison of the visual analogical scale and modified Borg scale for measurement of dyspnea during exercise.  Clin Sci. 1989;  76 277-282
    CrossrefPubMedGoogle Scholar
  • 45 Wilson R, Jones P. Differenciation between the intensity of breathlessness and the distress it evokes in normal subjects during exercise.  Clin Sci. 1987;  80 65-70
    PubMedGoogle Scholar

Professor S. Ahmaidi

Faculté des Sciences du Sport
Campus Universitaire Le Bailly

Allée P. Grousset

80025 Amiens Cedex

France

Phone: + 33 3 22 82 79 03

Fax: + 33 3 22 82 79 10

Email: said.ahmaidi@u-picardie.fr